The following is the first part of a paper I wrote for my yoga therapy program through Inner Peace Yoga Therapy. The rest of the paper will be published in 2 additional posts.
Introduction
Whatever you do is never enough. You know, it’s always do more... . And the more you do, the more it’s expected.” (de Figueiredo et al., 2014, p. 293)
“A lack of progress or feeling stuck with one or more clients can lead to compassion fatigue because it starts, for me, bringing up questions of ‘What am I really doing here? Am I making any kind of difference?’ Am I doing something wrong?’” (de Figueiredo et al., 2014, pp.291-292)
The quotes above are from service providers who work with highly traumatized children. What they are describing are some of the elements of burnout (BO) and compassion/empathy fatigue (CF). This post will explain what burnout and compassion/empathy fatigue area and common signs and symptoms. Future posts will give various perspectives on BO and CF, and how yoga therapy can serve both as a treatment approach for existing BO and CF and as tool for prevention. The self-care aspects of yoga put it in a unique position for burnout prevention.
Burnout & Compassion/Empathy Fatigue
The term burnout was developed in the 1970s by two American psychologists, Herbert Freudenberger and Christina Maslach, and has been most studied in helping professionals but could occur in any profession (Schaufeli, 2017). According to Maslach (2003), burnout is defined as a condition in which one becomes exhausted and hopeless in response to long-term workplace stressors. Maslach (2003) identified 3 dimensions of burnout: exhaustion (emotional, physical, spiritual), depersonalization (cynicism), and a sense of ineffectiveness and lack of accomplishment. Rate of burnout vary by profession and study, but to synthesize the data, a meta-analysis of 40 studies on burnout prevalence among psychotherapists found the average proportion of therapist reporting moderate-high level of burnout was 55% (Simionato & Simpson, 2018).
A related but different term is compassion/empathy fatigue. It is “the exhaustion and negative emotional, physiological, biological, and cognitive effects resulting from the cumulative effects of empathic engagement with, and secondary exposure to, trauma.” (de Figueiredo et al., 2014, p.286). Out of this experience with the indirect or secondary trauma exposure, one can develop secondary traumatic stress (STS) or vicarious trauma, which can mirror the symptoms of posttraumatic stress disorder (PTSD).
Sometimes there is confusion between the terms BO, CF and STS. Burnout is generally a broader term that could occur in any occupation or cause, and is seen as a component of CF. CF is more specific, involves empathy as a core component of the work, and thus is seen as occurring in helping professions such as health care (doctors, nurses, etc.), teachers, social workers, caregivers, first responders and psychotherapists. One model of CF posits that BO + STS = CF.
CF can also be conceptualized as a broader term that may not always include STS, but just working with people who are suffering in some way. For example, Newell and Nelson-Gardell (2014) state, “The chronic use of empathy combined with the day-to-day bureaucratic hurdles that exist for many social workers such as agency stress, billing difficulties, and balancing clinical work with administrative work generate the experience of compassion fatigue” (p. 430). As a social worker myself, I am interested in not only the general issue of burnout but also in addressing compassion/empathy fatigue. Throughout the paper, there will be references to both BO and CF.
Important to note are the corresponding concepts of engagement and compassion satisfaction. Engagement is often thought as the positive antithesis of burnout and can be thought of along the same dimensions of burnout mentioned above but the positive end: “High energy, strong involvement, and a sense of efficacy” (Maslach & Leiter, 2016, p.104). Compassion satisfaction (CS) is the positive antithesis to CF and “is defined as the positive effect on providers’ sense of fulfillment and pleasure resulting from effective clinical practice, particularly with traumatized populations” (de Figueiredo et al., 2014, p.287).
Causes, Signs, and Symptoms
Some of the causes of burnout are explored in the Areas of Worklife (AW) model of burnout (Maslach & Leiter, 2016). This model examines 6 key areas where imbalances can occur: workload, control, reward, community, fairness, and values. Each of these areas exists on a continuum and chronic extremes on one end can lead to burnout. For example, “work overload contributes to burnout by depleting the capacity of people to meet the demands of the job” (Maslach & Leiter, 2016, p.105). If this is chronic, there is little time for people to recover and restore balance.
Symptoms can often manifest along the 3 dimensions of burnout (exhaustion, depersonalization, and a sense of ineffectiveness). The dimension of exhaustion often manifests in health-related symptoms such as “headaches, chronic fatigue, gastrointestinal disorders, muscle tension, hypertension, cold/flu episodes, and sleep disturbances” (Maslach & Leiter, 2016, p.106). Cardiovascular issues and mental health problems, including substance abuse are also commonly associated health issues. Burnout is especially correlated with depression (Maslach & Leiter, 2016). Depersonalization can manifest as interpersonal conflict or less engagement with clients. It can manifest as feelings of suspiciousness, frustration, or anger. A sense of ineffectiveness can manifest as lower productivity and quality of work. For those with CF, additional symptoms of traumatic stress are often also present like intrusive thoughts, avoidance, hyperarousal, and feelings of fear or helplessness (de Figueiredo et al., 2014).
Conclusion
In this post, I have established a foundation of what burnout and compassion fatigue are, and common signs and symptoms. It’s important to have a clear understanding of what they are and why they occur, before jumping into how to prevent and address them. Now that they have been operationalized and examined, in part 2 I will examine how varied models and frameworks understand BO and CF.
Photo by Conscious Design on Unsplash
Stay tuned for Part 2: Various Perspectives on Burnout